title: Migraine headaches in chronic fatigue syndrome (CFS): comparison of two prospective cross-sectional studies.
abstract: BACKGROUND
  Headaches are more frequent in Chronic Fatigue Syndrome (CFS) than healthy control (HC) subjects. The 2004 International Headache Society (IHS) criteria were used to define CFS headache phenotypes.
  
  
  METHODS
  Subjects in Cohort 1 (HC = 368; CFS = 203) completed questionnaires about many diverse symptoms by giving nominal (yes/no) answers. Cohort 2 (HC = 21; CFS = 67) had more focused evaluations. They scored symptom severities on 0 to 4 anchored ordinal scales, and had structured headache evaluations. All subjects had history and physical examinations; assessments for exclusion criteria; questionnaires about CFS related symptoms (0 to 4 scale), Multidimensional Fatigue Inventory (MFI) and Medical Outcome Survey Short Form 36 (MOS SF-36).
  
  
  RESULTS
  Demographics, trends for the number of diffuse "functional" symptoms present, and severity of CFS case designation criteria symptoms were equivalent between CFS subjects in Cohorts 1 and 2. HC had significantly fewer symptoms, lower MFI and higher SF-36 domain scores than CFS in both cohorts. Migraine headaches were found in 84%, and tension-type headaches in 81% of Cohort 2 CFS. This compared to 5% and 45%, respectively, in HC. The CFS group had migraine without aura (60%; MO; CFS+MO), with aura (24%; CFS+MA), tension headaches only (12%), or no headaches (4%). Co-morbid tension and migraine headaches were found in 67% of CFS. CFS+MA had higher severity scores than CFS+MO for the sum of scores for poor memory, dizziness, balance, and numbness ("Neuro-construct", p = 0.002) and perceived heart rhythm disturbances, palpitations and noncardiac chest pain ("Cardio-construct"; p = 0.045, t-tests after Bonferroni corrections). CFS+MO subjects had lower pressure-induced pain thresholds (2.36 kg [1.95-2.78; 95% C.I.] n = 40) and a higher prevalence of fibromyalgia (47%; 1990 criteria) compared to HC (5.23 kg [3.95-6.52] n = 20; and 0%, respectively). Sumatriptan was beneficial for 13 out of 14 newly diagnosed CFS migraine subjects.
  
  
  CONCLUSIONS
  CFS subjects had higher prevalences of MO and MA than HC, suggesting that mechanisms of migraine pathogenesis such as central sensitization may contribute to CFS pathophysiology.
  
  
  BACKGROUND
  Georgetown University IRB # 2006-481
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Georgetown University, 3800 Reservoir Road NW, Washington, DC 20007-2197, USA.
authors.forename: Murugan K
authors.initials: MK
authors.lastname: Ravindran
authors.forename: Yin
authors.initials: Y
authors.lastname: Zheng
authors.forename: Christian
authors.initials: C
authors.lastname: Timbol
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Merck
authors.forename: James N
authors.initials: JN
authors.lastname: Baraniuk
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015673:Fatigue Syndrome, Chronic / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005356:Fibromyalgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy / Q000453:epidemiology*; D010146:Pain / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D057566:Self Report; D012720:Severity of Illness Index; D018170:Sumatriptan / Q000627:therapeutic use*; D018781:Tension-Type Headache / Q000453:epidemiology
chemical_list: D018170:Sumatriptan